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Rivera-Pérez D, Rosa-Carrasquillo C, Reyes-Sullivan AJ, Torres-Pérez H, Crespo MJ. Anesthetic Management Including Postoperative Regional Anesthesia in a Young Adult Patient With Von Willebrand Disease and Osteogenesis Imperfecta. Cureus 2023; 15:e40363. [PMID: 37456380 PMCID: PMC10339853 DOI: 10.7759/cureus.40363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/18/2023] Open
Abstract
There are no established guidelines regarding anesthesia with a peripheral nerve block (PNB) in the young adult population with von Willebrand disease (vWD) type I. We present a case of a successful PNB outcome in a 20-year-old male patient with vWD type I, osteogenesis imperfecta (OI), and rheumatoid arthritis (RA) who underwent an intramedullary nailing surgery after suffering a left distal femur fracture secondary to a sports injury. Before the procedure, the patient was treated with HUMATE-P® [antihemophilic factor and von Willebrand factor (human)], ALPHANATE® (antihemophilic factor/von Willebrand factor complex), and aminocaproic acid for hematologic control. Left femoral and popliteal nerve blocks were performed for postoperative pain control. The patient was discharged home uneventfully three days after the surgery. In this case, PNB proved to be a safe and effective alternative in the management of a vWD type I young adult patient with comorbidities. Given the lack of established guidelines, a multidisciplinary team should be involved in the pre and perioperative management of these patients due to the risk of delayed bleeding.
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Affiliation(s)
- Dennys Rivera-Pérez
- Anesthesiology, University of Puerto Rico, Medical Sciences Campus, San Juan, USA
| | | | | | - Hector Torres-Pérez
- Anesthesiology, University of Puerto Rico, Medical Sciences Campus, San Juan, USA
| | - Maria J Crespo
- Anesthesiology, University of Puerto Rico, Medical Sciences Campus, San Juan, USA
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Franchini M, Mannucci PM. Acquired von Willebrand syndrome: focused for hematologists. Haematologica 2020; 105:2032-2037. [PMID: 32554559 PMCID: PMC7395262 DOI: 10.3324/haematol.2020.255117] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/27/2020] [Indexed: 12/16/2022] Open
Abstract
The acquired von Willebrand syndrome (AvWS) is a rare bleeding disorder with laboratory findings similar to those of inherited von Willebrand disease. However, unlike the inherited disease, AvWS occurs in persons with no personal and family history of bleeding and is often associated with a variety of underlying diseases, most frequently lymphoproliferative, myeloproliferative and cardiovascular disorders. After the presentation of a typical case, in this narrative review we discuss the more recent data on the pathophysiology, clinical, laboratory and therapeutic aspects of this acquired bleeding syndrome. We chose to focus particularly on those aspects of greater interest for the hematologist.
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Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantua
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
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De Padua V, Romeo U, Santoro C, Bosco R, Baldacci E, Ferretti A, Malaspina F, Mazzucconi MG, Gaglioti D. Dental invasive procedures in von Willebrand disease outpatients treated with high purity FVIII/VWF complex concentrate (Fanhdi®): experience of a single center. Heliyon 2020; 6:e03426. [PMID: 32140581 PMCID: PMC7044789 DOI: 10.1016/j.heliyon.2020.e03426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/18/2019] [Accepted: 02/12/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To retrospectively assess the effectiveness and safety of customized hemostatic protocols using a plasma-derived, von Willebrand Factor (VWF)-containing Factor VIII concentrate (pdVWF/FVIII) in von Willebrand disease (VWD) patients undergoing dental invasive procedures. METHODS Protocol for each patient was drawn up by the Blood Unit based on the VWD type, disease severity, and type of treatment. pdFVIII/VWF infusions and doses were registered at 30-60 min before intervention (t0) and at 12-24-36-48-72 h after intervention (t12-t72) and up to day 7. Any peri- or postoperative bleeding, complication or adverse event was registered. RESULTS Forty-five dental procedures were performed on 20 VWD patients (six type-1, two type-2a, six type-2b, six type-3). Most pdFVIII/VWF infusions at t0 were 60 IU/kg (n = 7) and 50 IU/kg (n = 9). Subsequent infusions were mostly 30-50 IU/kg. No bleeding complications or adverse events were reported. CONCLUSION This study supports the safety and efficacy of pdFVIII/VWF to prevent peri- and postoperative bleeding after invasive oral procedures.
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Affiliation(s)
| | - Umberto Romeo
- Department Head-Neck, Sapienza University, Rome, Italy
| | - Cristina Santoro
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
| | | | - Erminia Baldacci
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
| | - Antonietta Ferretti
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
| | - Francesco Malaspina
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
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Oshika H, Koyama Y, Tsuzaki K, Ida K, Andoh T. Perioperative management of a pediatric patient with suspected type 1 von Willebrand disease undergoing tonsillectomy: a case report. JA Clin Rep 2019; 5:54. [PMID: 32026008 PMCID: PMC6966984 DOI: 10.1186/s40981-019-0276-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/22/2019] [Indexed: 11/18/2022] Open
Abstract
Background Von Willebrand disease (VWD) is the most common inherited bleeding disorder in humans. Coagulopathies such as VWD are evidently risk factors for post-surgical bleeding. Perioperative management of patients with VWD remains controversial and is a major clinical concern. Case presentation A 5-year-old girl was scheduled for tonsillectomy under general anesthesia. Preoperative laboratory tests revealed prolongation of activated partial thromboplastin time and a mild decrease in von Willebrand factor (VWF) activity. Prophylactic administration of desmopressin or VWF was not performed. During tonsillectomy, oozing from the surgical wound was uncontrollable by conventional hemostasis techniques, but complete hemostasis was ensured by plasma-derived coagulation factor VIII concentrate containing VWF. Conclusion Pediatric patients with mild abnormalities in preoperative laboratory tests may have coagulopathies. Prophylactic intervention and/or the preparation of a sufficient amount of coagulation factor VIII concentrate containing VWF may be required in patients suspected of having VWD or with mild VWF deficiency.
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Kornhuber KTI, Seidel H, Pujol C, Meierhofer C, Röschenthaler F, Pressler A, Stöckl A, Nagdyman N, Neidenbach RC, von Hundelshausen P, Halle M, Holdenrieder S, Ewert P, Kaemmerer H, Hauser M. Hemostatic abnormalities in adult patients with Marfan syndrome. Cardiovasc Diagn Ther 2019; 9:S209-S220. [PMID: 31737529 DOI: 10.21037/cdt.2019.08.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Aortic root ectasia might induce hemostatic disorders in patients with Marfan syndrome (MFS) via altered blood flow and rheology. The aim of this study was to explore the hemostasis in patients with MFS compared with healthy controls. Methods In this cross-sectional case-control study we included patients with verified MFS (n=51) and sex- and age-matched healthy controls (n=50). Main criteria were the aortic root in echocardiography and cardiac magnetic resonance imaging (MRI), and the coagulation status. Results When compared with healthy controls, patients with MFS showed significantly increased diameters of the aortic roots (43.0±7.72 vs. 28.8±3.74 mm, P<0.001) and aortic Z-scores (4.36±2.77 vs. 0.948±1.09, P<0.001), considerably higher values of Multiplate® tests (e.g., MP-ADP: 878.4±201.7 vs. 660.4±243.6 AU*min, P<0.001) and PFA-100® tests (PFA Col/ADP: 102.5±45.5 vs. 91.1±46.2 s, P<0.05), PTT (30.0±3.91 vs. 28.7±2.50 s, P<0.05) and D-dimers (0.488±0.665 vs. 0.254±0.099 mg/L, P<0.001). In MFS von Willebrand factor (VWF) activity (81.9%±41.8% vs. 106.3%±41.5%, P<0.05) and antigen (93.8%±43.9% vs. 118.8%±47.8%, P<0.05) and factor VIII activity (108.9%±29.6% vs. 126.7%±28.4%, P<0.05) were reduced. Significant positive correlations were found between aortic diameters and D-dimers (all P<0.05), as well as PFA Col/ADP (all P<0.01) in MFS patients. Factor VIII activity correlated significantly negatively with the diameter of the aortic root in MFS (r=-0.55, P<0.05). Conclusions In conclusion, our study reveals hemostatic deviations in patients with MFS. Further studies are necessary to understand the causal relationship and the exact pathomechanism.
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Affiliation(s)
- Katharina T I Kornhuber
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Heide Seidel
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany.,Institute of Human Genetics, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Claudia Pujol
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Christian Meierhofer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Franz Röschenthaler
- Institute of Laboratory Medicine, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Axel Pressler
- Outpatients' Clinic for Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Alexander Stöckl
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Rhoia C Neidenbach
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Philipp von Hundelshausen
- Institute for Cardiovascular Prevention, Faculty of Medicine, Ludwig Maximilian University, Munich, Germany
| | - Martin Halle
- Outpatients' Clinic for Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Michael Hauser
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
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Fatal Intramyocardial Hemorrhage After Pericardiotomy in a Patient With von Willebrand Disease. ACTA ACUST UNITED AC 2016; 7:99-102. [PMID: 27580407 DOI: 10.1213/xaa.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with large pericardial effusions and possible tamponade undergoing general anesthesia for pericardial drainage are generally thought to be at a highest risk of cardiovascular collapse before drainage of the effusion. Here, we report a case of extensive and fatal intramyocardial hemorrhage after drainage of a pericardial effusion in a patient with von Willebrand disease.
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